Provider Demographics
NPI:1467138883
Name:AVALI MEDTECH LLC
Entity Type:Organization
Organization Name:AVALI MEDTECH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HAWRAA
Authorized Official - Middle Name:
Authorized Official - Last Name:NASSIRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-948-5354
Mailing Address - Street 1:17220 W 12 MILE RD STE 111
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2114
Mailing Address - Country:US
Mailing Address - Phone:313-948-5354
Mailing Address - Fax:
Practice Address - Street 1:17220 W 12 MILE RD STE 111
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2114
Practice Address - Country:US
Practice Address - Phone:313-948-5354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies